People should not be harmed by an accident or mistakes when they receive care.
Long-term care residents and staff should experience a safe home and work environment, free from any kind of abuse, neglect, avoidable injury or harm. Homes should aim to reduce or eliminate the risk of harm by preventing falls and pressure ulcers, managing medication for drug safety, minimizing the use of restraints, making sure staff are properly trained and have access to necessary equipment and technology, practising rigorous infection control, and implementing other evidence-based policies that ensure a safe care environment.
Health Quality Ontario currently reports on four quality indicators for the safety of long-term care. These indicators relate to falls, pressure ulcers, restraints and medication safety. To learn more, click on the tabs above.
Percentage of residents
who had a recent fall
2013/14 provincial average:
14.2%
2012/13 provincial average:
13.8%
Falls
This indicator shows the percentage of long-term care residents in Ontario who fell in any given 30-day period.
Residents can experience serious consequences after a fall, including injuries that limit their independence and increase their care needs. Falls also affect other parts of the health care system, leading to more emergency department visits, hospitalizations and surgeries. The Long-Term Care Homes Act, 2007, requires all homes in Ontario to have a falls prevention and management program to reduce the incidence of falls and the risk of injury.
Percentage of residents who had a pressure ulcer that recently worsened
2013/14 provincial average:
3.0%
2012/13 provincial average:
2.9%
Pressure Ulcers
This indicator shows the percentage of long-term care residents in Ontario who developed a more severe pressure ulcer over any given 90-day period.
Pressure ulcers, often called bedsores, are injuries to the skin and/or underlying tissue that can develop when a long-term care resident has been sitting or lying down in one place for too long. Residents who develop pressure ulcers are at risk of serious health complications, such as infections and severe pain. Pressure ulcers are also very difficult and expensive to treat. The Long-Term Care Homes Act, 2007, requires all homes in Ontario to have a skin and wound care program to promote skin integrity, prevent the development of wounds and pressure ulcers, and provide effective skin and wound care interventions.
Percentage of residents who were physically restrained
2013/14 provincial average:
8.9%
2012/13 provincial average:
11.0%
Restraints
This indicator shows the percentage of long-term care residents in Ontario who were physically restrained on a daily basis over any given 90-day period.
This indicator only includes trunk and limb restraints, and chairs that prevent people from rising. Other types of restraints, including chemical restraints (i.e., drugs) and bed rails, are not included in this calculation.
Some long-term care homes use restraints as a way of managing potentially harmful resident behaviours, such as wandering or aggression (e.g., hitting). Residents who display these behaviours often have dementia or other cognitive impairments and can sometimes pose a risk to themselves or others. However, restraints limit mobility, increase the risk of pressure ulcers, and can cause agitation and confusion. In rare cases the use of restraints can lead to a resident’s death. For these reasons, it is important to limit the use of restraints and to find alternate ways of managing dementia-related behaviours. The Long-Term Care Homes Act, 2007, requires all homes in Ontario to have policies in place to minimize restraining residents. Any necessary restraint must be done in accordance with the requirements under the Act.
Number of residents prescribed a drug that should never be used among the elderly per 100,000 residents aged 65 years or older,
per year
2012/13 provincial average:
33 per 100,000
2011/12 provincial average:
44 per 100,000
Medication Safety
This indicator shows the rate of long-term care residents prescribed a drug that should always be avoided by the elderly per 100,000 residents in Ontario aged 65 years or older, per year. To calculate this indicator, Health Quality Ontario uses a list of drugs adopted from work endorsed by the Agency for Healthcare Research and Quality in the United States.
Although medications play an important role in managing illness, they can also be associated with side effects and complications. Certain drugs should never be used by the elderly because of their limited effectiveness in older adults and the possibility of dangerous side effects, unnecessary illness, emergency room visits and hospitalizations. The Long-Term Care Homes Act, 2007, requires all homes in Ontario to have an interdisciplinary medication management system in place that provides safe medication management and optimizes effective drug therapy outcomes for residents.